Operable Breast Carcinoma Research Articles

Four Node Sampling: Is It an Effective Alternative to Sentinel Lymph Node Biopsy in Low-resource Settings for Breast Cancer Management

Abstract Background: Breast cancer is the most common malignancy among women globally, with regional lymph nodal involvement being a key determinant in staging. “Node positive” breast cancer patients have 40% higher mortality. Axillary lymph node dissection (ALND) is the standard of care in the surgical management of the axilla but is associated with significant morbidity, especially lymphedema. To decrease morbidity especially in node-negative patients, sentinel lymph node biopsy (SLNB) has emerged as an alternative due to its low false-negative rates (FNRs), better sensitivity and specificity. However, in austere settings scenarios where the facility for SLNB is not available, four-node axillary sampling (FNAS) has been explored with variable outcomes. This study evaluates the feasibility of FNAS in the management of node-negative, postneoadjuvant, operable breast cancer patients at our institution. Methods and Results: This observational prospective study included 37 patients with clinically node-negative, operable breast cancer, following neoadjuvant chemotherapy. FNAS was performed using methylene blue dye to identify and dissect four axillary nodes and sent for a frozen section. Subsequently, ALND was done as per standard practice. The performance of FNAS as an alternative to SLNB showed a sensitivity of 81%, specificity of 100%, positive predictive value of 100%, and negative predictive value (NPV) of 69%. The FNR was 19.2% with an overall diagnostic accuracy of 86%. Conclusion: While ALND remains the standard for axillary staging in operable breast carcinoma, SLNB is validated as a useful method for axillary staging in node-negative patients. FNAS demonstrated high false-negative rates and limited diagnostic value in this study. Further research, including larger studies and randomized controlled trials comparing FNAS with SLNB is needed to establish its efficacy and potential role in the management of node-negative breast cancer.

Prognostic Significance of Angiogenesis in invasive ductal carcinoma

Background: Angiogenesis is essential for tumor growth and metastasis. Axillary lymphnode status has been the most important prognostic factor in operable breast carcinoma, but it does not fully account for the varied disease outcome. More accurate prognostic indicators would help in selection of patients at high risk for disease recurrence and death who are candidates for systemic adjuvant therapy. Microvessel density in invasive ductal carcinoma (measures of tumor angiogenesis) is associated with metastasis and thus may be a prognostic indicator. Objective: To correlate intratumoral and peritumoral angiogenic microvessel density with lymphnode metastasis in invasive ductal carcinoma. Material and Methods: It is a cross sectional observational study, carried out at the department of Pathology, BSMMU from January 2016 to December 2017. A total 48 mastectomy samples with axillary nodes from histologically confirmed invasive ductal carcinoma were included in this study. Weidner method was used for calculating micro vessels density. Sections examined to evaluate the density of angiogenic vessels by immuohistological stain with vWF expression in invasive breast cancer. Correlation between angiogenic vessels density with or without lymphnode metastasis was taken. Results: In this study angiogenic vessel count is more in the intratumoral area than peritumoural area. There was a positive significant correlation between lymphnode metastasis with micro vessel density in both peritumoral and intratumoral areas in Weidner method in vWF stain. J Shaheed Suhrawardy Med Coll 2023; 15(1): 59-65

An Observational Study of Association of Clinicopathological Stage and Ki-67, P53, Human Epidermal Growth Factor Receptor 2/neu, Estrogen Receptor, and Progesterone Receptor Status in Breast Cancer

ABSTRACT Objectives: The objective was to study the association between the clinicopathological stage of breast cancer and lymph node (LN) involvement with respect to Ki-67, P53, human epidermal growth factor receptor (HER2/neu), estrogen receptor (ER), and progesterone receptor (PR) status. Methods: This observational cross-sectional study, conducted in a tertiary care hospital, included 100 adult female patients with operable breast carcinoma. The histopathological investigations, including histopathological typing and immunohistochemistry (IHC) (ER, PR, HER2/neu, Ki-67, and p53), were done. For IHC, a cutoff of 10% stained cells or more was considered positive for ER, PR, p53, and HER2/neu, and a cutoff of >14% stained cells was considered positive for Ki-67 expression. The interrelation of markers with clinical stage and LN involvement was evaluated. Results: ER, PR, and HER2/neu status were positive in 56%, 42%, and 22% of cases. Ki-67 ≥14% was present in 94% of cases. P53 was positive in 14% of cases. P53 and Ki-67 showed a significant association with tumor (T), nodes (N), and metastases (M) staging. As for the IHC of axillary LN s, only Ki-67 increased expression (≥14%) showed a significant association with P = 0.01. For the clinical staging, no markers among ER, PR, HER2/neu, Ki-67, and p53 showed a significant association. Conclusion: To conclude, p53 increased mutation and Ki-67 expression hold a significant association with the increasing stage of breast cancer and axillary lymphadenopathy.

Axillary management in older women with early operable invasive breast carcinoma: a narrative review

Axillary management in older women with early operable invasive breast carcinoma: a narrative review

Association of Serum Fibrinogen and Plasma VEGF Levels with Tumor Characteristics and Treatment Response in Operable Breast Carcinoma

A search for factors predicting the behavior of the tumor, its invasiveness, metastasis, response to treatment, and prognosis is the primary focus of breast cancer research. The objective of the present study was to study the association of fibrinogen and vascular endothelial growth factor (VEGF) with various parameters of breast carcinoma. A case control was conducted in which fibrinogen, and VEGF levels were compared between cases and controls and also with various characteristics of breast carcinoma such as T stage, lymph node positivity, grade, lymphovascular invasion, and receptor status. The effect of surgery of breast cancer on fibrinogen and VEGF levels was also studied. The levels of fibrinogen and VEGF were significantly higher in cases when compared to controls (p < 0.001). Increased fibrinogen level was significantly associated with higher grade of the tumor, lymph node metastasis, and lymphovascular invasion. Increased VEGF level was significantly associated with higher grade and lymphovascular invasion of the tumor. After treatment, there was a statistically significant fall in the levels of the above mediators (p < 0.001). Serum fibrinogen and plasma VEGF levels were significantly higher in patients of breast carcinoma and had significant association with invasiveness of the tumor.

The Role of Adjuvant Chemotherapy in Metaplastic Breast Carcinoma: A Competing Risk Analysis of the SEER Database.

Purpose: Chemotherapy is the clinically recommended treatment for patients with operable metaplastic breast carcinoma (MBC); however, its impact remains controversial. This study investigated the possible role of chemotherapy in the treatment of MBC.Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify the operable MBC patients. The competing risk analysis along with the propensity score matching (PSM) method was performed to evaluate the effect of chemotherapy. Moreover, a competing risk nomogram was built to identify prognosis in patients with MBC.Results: Of the 1137 patients with MBC, 775 received chemotherapy and 362 did not receive chemotherapy. The 5-year cumulative incidence of breast cancer-specific death (BCSD) showed similar outcomes in both the Chemo and No-Chemo groups (21.1 vs. 24.3%, p = 0.57). Chemotherapy showed no apparent association with BCSD (HR, 1.07; 95% CI, 0.72–1.60; p = 0.72), even after subgroup analysis or PSM. Race, tumor size, lymph node status, and radiation were identified as the significant factors for MBC after a penalized variable selection process. In addition, a competing risk nomogram showed relatively good accuracy of prediction with a C-index of 0.766 (95% CI, 0.700–0.824).Conclusion: Our findings demonstrated that chemotherapy did not improve BCSD for operable MBC patients. Thus, it may indicate the need to reduce exposure to the current chemotherapy strategies for patients with resectable MBC. Additionally, some novel treatment strategies are required urgently to identify and target the potential biomarkers.

Total Tumor Load of mRNA Cytokeratin 19 in the Sentinel Lymph Node as a Predictive Value of Axillary Lymphadenectomy in Patients with Neoadjuvant Breast Cancer.

Although sentinel lymph node biopsy (SLNB) has proved to be able to diagnose axillary lymph node status safely and reliably, there is still not enough evidence to suggest that it can be used in patients who have undergone neoadjuvant chemotherapy (NAC) for lymph node-sparing surgery. The present study used molecular approaches to determine whether SLNB can be reliably used in patients who have been treated with NAC before SLN surgery, and whether the total tumor load of the SLN can be used as a predictive factor in axillary lymphadenectomy (ALD). We used one-step nucleic acid amplification (OSNA) to analyze a total of 111 consecutive patients who presented operable invasive breast carcinomas and who had been treated with NAC. SLN was positive in 55 patients and the identification rate was 100%. In 9 of these 55 patients, ALD showed that other lymph nodes were also involved. In all of the other 46 patients, the only lymph node to be identified as positive was SLN. Metastasis was not found in any of the axillary lymph nodes in the isolated tumor cell group. The total tumor load, defined as the amount of cytokeratin 19 mRNA copy numbers in all positives SLN (copies/µL), showed three risk groups related to the possibility of positive non-sentinel nodes. OSNA is a diagnostic technique that is highly sensitive, specific, and reproducible and it can be used to analyze sentinel lymph nodes after NAC. Total tumor load may be able to help predict additional metastases in axillary lymphadenectomy.

Post-irradiation morphea: An under reported complication

Post irradiation morphea (PIM) is a rare complication of radiotherapy, which occurs abruptly after an asymptomatic period of one month to three years and presents with painful sclerotic plaques associated with severe pain and disfigurement. We are reporting a 55-year-old patient of operated breast carcinoma, post chemotherapy; who developed PIM five months after completion of radiotherapy. PIM being a complication of radiotherapy with unpredictable risk factors is an underdiagnosed condition. Early suspiscion of the disease is necessary in order to avoid irreversible complications.

Elastin and collagen IV double staining: A refined method to detect blood vessel invasion in breast cancer.

Blood vessel invasion (BVI) is a prognostic indicator in various cancers. Elastic stain, which highlights blood vessel walls, is commonly used to detect BVI. In the breast, however, its diagnostic usefulness is limited because it also highlights some intraductal carcinoma components, which often mimic BVI. In this study, we aimed to improve BVI detection in breast cancer and developed a double staining: Victoria blue for elastin and immunohistochemistry for collagen IV. Collagen IV fibers were retained along the basement membranes of intraductal carcinoma components, whereas they were rearranged or lost in BVI. From these observations, we defined BVI as the presence of tumor cells inside an elastic ring with a rearrangement or loss of collagen IV fibers. Using these criteria, we found BVI in 148 cases (49%) among 304 cases of primary operable invasive breast carcinoma, and the presence of BVI correlated significantly with poor prognosis. By contrast, we detected BVI in 94 cases (31%) or 14 cases (5%) by elastic van Gieson or CD31 immunostaining among the same cases, respectively, with no statistically significant association with prognosis. Thus, elastin and collagen IV double staining facilitates the detection of BVI in breast cancer and is useful to predict prognosis.

Nottingham Prognostic Index: Useful tool to assess outcome inpatients of breast carcinoma

Breast cancer has been ranked number one cancer among the Indian females surpassing the incidence of cervical cancer. Multiple clinico-pathological-molecular prognostic factors are available in decision making about potentially suitable treatment options for breast cancer. Among all, Nottingham Prognostic Index (NPI) is the most powerful integrated index. Present study aimed to evaluate the significance of NPI in prognosis of operable breast cancer patients. This longitudinal (Descriptive) study was carried on 60 female patients of operable breast carcinoma at tertiary care centre in central India. Two patients from good prognostic group (NPI3.4) (30%) had metastasis to bone &amp; CNS. F rom moderate prognostic group ((NPI 3.4 - 5.4) (50%) , one patient had recurrence at previous surgical scar site and 3 patients had metastasis to liver, lung and supraclavicular lymph node each. However the worst outcome was found in patients from poor prognostic group (NPI &amp;#62; 5.4) (10%). Five patients from poor prognostic group had metastasis in liver, bone, CNS and lung with two patients had simultaneous metastasis in liver &amp; bone. Four patients from poor prognostic group had death within two and half year s of primary diagnosis. Out of 60 patients, 34 patients had a follow up of more than 1000 days, so were included in statistical analysis of survival based on Cox Proportional Hazard Model. Among 7 variables, NPI was found to be statistically most significant with p value 0.001 Estimation of NPI is the powerful and reproducible index for assessing prognosis in patients with operable breast cancer in advanced resources deprived institute. Main strength of NPI lies in the fact that it is based on relatively simple data which can be provided in routine histopathology report of carcinoma breast.

Evaluation of locoregional recurrence in patients with early breast carcinoma post-breast-conserving surgery with and without the use of preoperative chemotherapy

The effects of neoadjuvant chemotherapy in increasing the rate of conservative breast therapy and associated with reducing morbidity and better cosmetic has been fully acknowledged. Now, there are commonly used neoadjuvant chemotherapy for operable early breast carcinomas patients. Currently, neoadjuvant chemotherapy is used for locally advanced breast carcinoma, inflammatory breast cancer, and down staging of the large tumor to allow for breast conservative therapy. A prospective study performed in the department of surgery in Al-Sadder Medical City/Najaf city/Iraq, from the …….. of October 2015 to the 1st of October 2018, where 48 patients presented with a breast cancer diagnosis by clinical examination, Mammography, breast ultrasound, chest x-ray, bone scan, serum CEA, CA15_3 level, the initial diagnosis of breast cancer made by core needle biopsy. Breast saving surgery consisted of wide local excision with a safe margin with standard level I, II lymph node of axilla dissection. The resected specimen and lymph node was sent for histopathological examination; the size, width, length &amp;height dimension were recorded and the resection margin was recorded positive if close to 2mm and negative if &gt;2mm tumor-free margin. The 48 patients enrolled in this study with a mean age at diagnosis of 44.6 ± 8.4 years. 34 patients received neoadjuvant chemotherapy, Locoregional recurrence reported in 4 patients (28.6%) not received neoadjuvant chemotherapy (P. value &lt; 0.001), the higher relapse rate was reported significantly in the cases aged more than 50 years compared to those aged 50 years or below (P. value = 0.05, significant). Neoadjuvant chemotherapy decreases the incidence of locoregional recurrence of early breast carcinoma after breast-conserving surgery.

Role of D-dimer in patients of operable breast cancer with lymph node metastases: A matched cross-sectional study

Introduction: Breast cancer is the most common malignancy amongst women worldwide. Presence of axillary lymph nodes metastases is an important predictor of survival in patients with infiltrative breast cancer. D-dimer levels are elevated in the plasma of various solid tumor patients. There still exists a gap in our knowledge regarding the relationship between quantitative D-dimer levels and extent of disease in primary breast cancer. Aim: To study the fibrinolytic pathway by assaying D-dimer in breast cancer cases and to calculate a suggestive cutoff value for D-dimer for its use a specific marker of lymph node metastasis preoperatively in the cases of breast cancer. Materials and Methods: In this matched cross-sectional hospital-based study, 50 diagnosed cases of operable breast carcinoma not taking any treatment for the cancer and 50 healthy women both in the 25–65 years age group were selected as cases and controls, respectively. Peripheral venous blood was collected and analyzed for prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), D-dimer, platelet count, and mean platelet volume. Results: D-dimer was significantly increased in cases compared to healthy controls. It was markedly increased in patients with lymph node involvement irrespective with the number of nodes involved, while PT, aPTT, and TT did not show significant difference. Receiver operating characteristic curve gave a sensitivity of 56% and specificity of 91%, for cutoff value of 0.765 for D-dimer, in order to predict the chances of lymph node metastases preoperatively. Conclusions: D-dimer is a simple, noninvasive, quick, and nonexpensive laboratory investigation which can be used as a predictor of depicting lymph node metastasis.

Impact of focality on prognostication of early and operable breast carcinomas of no special type.

Multifocal/multicentric (MF/MC) breast carcinomas are not uncommon and its prognostic significance debated. We attempted to analyze the association of focality and prognostic factors in operated pT1 and pT2 breast carcinomas of no special type (NST). Retrospectively identified pathologically proven 124 unifocal (UF) and 49 MF/MC pT1 and pT2 breast carcinomas of NST over the past three years were compared in terms of clinical and pathological factors. The patients with MF/MC NST tumors were more likely to undergo radical surgery (P = 0.028). The tumors showed higher incidence of lymphovascular invasion (P = 0.024), perineural invasion (P = 0.046), ductal carcinoma in situ component (P < 0.001), higher number of positive axillary lymph nodes (P < 0.001), and higher anatomical staging (P = 0.048) when compared to the UF counterparts. Morphological intertumoral heterogeneity was noted in MF/MC tumors in 16 of 49 cases (32.65%). Most published studies on MF breast cancers have included all histological types and varying definitions. We included only pathologically defined stages and a single histological type to ensure "purity" of the groups. Higher anatomic staging and morphological interlesional heterogeneity suggest that early MF/MC tumors represent multiple primaries with a different biology. Careful consideration of features of each focus needs to be considered when deciding appropriate adjuvant therapy and for accurately prognosticating these patients. Immunohistochemical and morphological (grade) heterogeneity between the different foci may pose problems with "prognostic stage grouping" these tumors according to the American Joint Committee on Cancer staging system (8th edition).

Utility of One-Step Nucleic Acid (OSNA) cytokeratin-19 amplification assay total tumour load (TTL) in survival prediction, in primary operable invasive breast carcinoma

Introduction: One-Step Nucleic acid Amplification (OSNA) can be used to quantitatively stage axillary node involvement in patients with breast carcinoma. Recently, OSNA total CK19mRNA copy number (total tumour load, TTL) has been shown to correlate with disease-free, local recurrence-free and overall-survival. We assessed the utility of OSNA TTL as a substitute for histological axillary node staging in determining prognosis within two prediction models.

Abstract P3-02-01: Impact of prognoses on the discrepancies in histological grade of breast cancer between core needle biopsy and surgical excision specimen

Abstract Purpose: The high reliability and utility of core needle biopsy (CNB) have been previously described. Histological grade in CNB is one of the main determinants of the need for neoadjuvant systemic therapy. Our aim in this study was to clarify the host and histopathological factors influencing the discrepancies in histological grade (HG) between CNB and surgically excision specimen (SES). Methods: A total of 1342 operable invasive breast carcinoma biopsies were assessed and compared with surgical specimens in our hospital. Patients who required neoadjuvat chemotherapy were excluded. Histological grade (tubule formation, nuclear pleomorphism and mitotic index) was assessed between paired CNB and SET samples. ER and PgR status were determined using immunohistochemistry(IHC). HER2 status was determined using IHC and scored from 0 to 3+. Fluorescence in-situ hybridization analysis was carried out in HER2 2+ cases. The cut off point for ER and PgR positivity was set at 1%. Results: The clinicopathological characteristics of tumors showed in Clinico-pathological characteristics of 1342 patients and tumors by discordance group between CNB and SES for histological grade LL groupHH groupHL groupLLHgroupp valupTT1a31 (94%)0(0%)2(6%)0(0%)0.001 T1b162(92%)4(2%)1(1%)10(6%) T1c421(79%)43(8%)14(3%)52(10%) T2335(68%)63(13%)10(2%)82(17%) T352(68%)8(10%)2(3%)15(19%) T425(71%)4(11%)0(0%)6(17%) pNnegtive668(78%)73(9%)13(2%)101(12%)0.08 positive358(74%)49(10%)16(3%)64(13%) lynegative600(79%)6(4(8%)14(2%)85(11%)0.18 positive426(74%)58(10%)15(3%)80(14%) vnegative799(80%)81(5%)23(2%)98(10%)0.001 positive227(67%)41(12%)6(2%)67(20%) ER/PgRmegative82(33%)83(33%)13(5%)72(29%)0.001 positive944(86%)39(4%)16(1%)93(9%) HER2negative932(80%)86(7%)22(2%)121(10%)0.001 positive94(52%)36(20%)7(4%)44(24%) CNB;core needle biopsy, SES;surgical excision specimen, HH group (high grade in CNB/high grade in SES), LL group (low grade in CNB/low grade in SES), HL group (high grade in CNB/low grade in SES) and LH group (low grade in CNB/high grade in SES) . The concordance rates of HG of luminal type, HER2 type luminal HER2 type and Triple negative type in CNB and SES were 91%, 64%, 73% and 66%, respectively (p&amp;gt;0.001). Factors of discrepancy were T size, vessel invasion and ER/HER2 status for HG. The discrepancy factors were assessed with univariate and multivariate analysis. The underestimate and overestimate rates of HG in CNB compared to SES were7.5% and 1.3% in ER(+)HER2(-) type, 32%, and 3.1% in HER2 type, 22% and 4.3% in ER(+) HER2(+) type and 29% and 5.5% in Triple negative type(TN), respectively. The concordance rates of tubule formation, nuclear pleomorphism and mitotic index in CNB and SES were 81%, 97% and 93% in luminal type, 85%, 66% and 33% in HER2 type, 77%, 87% and 83% in luminal HER2 type and 82%, 67% and 73% in TN type respectively. Conclusions: Using the largest known dataset to date of paired samples from a single institution, we evaluated the accuracy of CNB and the discrepancy factors between CNB and SES in breast cancer patients. We conclude that CNB for histological grade assessment in patients with HER2 positive or TN breast cancer before neoadjuvant treatment should be used with caution. Citation Format: Nakamura R, Yamamoto N, Miyaki T, Teranaka R, Itami M. Impact of prognoses on the discrepancies in histological grade of breast cancer between core needle biopsy and surgical excision specimen [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-02-01.

Response to neoadjuvant chemotherapy in operable breast carcinoma and conversion of modified radical mastectomy to breast conservation surgery, long term results: an Indian perspective

Background: This was a prospective study conducted in a tertiary care hospital over a period of one year w.e.f 01.09.06 to 31.08.07 and included 25 female breast cancer patients who were fine needle aspiration cytology proven. The objective of this study was to observe the response to neoadjuvant chemotherapy (NACT) in T1-T3, N0-N1, M0 patients and to determine the % of patients on whom breast conservation surgery could be performed. Majority of the patients were in 5th or 6th decades of life.Methods: Thorough clinical examination, bilateral mammography and ultrasound of the diseased breast was performed before administering CAF (cyclophosphamide, doxorubicin and 5-Fluorouracil) based NACT. Majority of the patients received three cycles of NACT. All patients tolerated the treatment well without any severe adverse effects.Results: Overall 84% of the patients showed response to NACT with 12% showing complete clinical regression of the primary tumour. The incidence of clinically negative axilla increased from 20% to 48% after NACT. The breast conservation surgery (BCS) rate increased from 12% to 64% after NACT.Conclusions: Of 16 patients who had undergone BCS, one patient had ipsilateral breast recurrence at four years and another one at six years of follow up; that proves the importance and success of BCS in carefully selected patients in our setup.

Breast Conservation Surgery after Neoadjuvant Chemotherapy in Responders in Operable Breast Carcinoma: A Better Alternative.

Breast Conservation Surgery after Neoadjuvant Chemotherapy in Responders in Operable Breast Carcinoma: A Better Alternative.

Intraoperative molecular analysis of sentinel lymph nodes following neoadjuvant chemotherapy in patients with clinical node negative breast cancer: An institutional study.

Sentinel lymph node biopsy (SLNB) is an accurate, safe method for determining the axillary lymph node status. However, insufficient evidence exists to support the recommendation of SLNB in patients who have had neoadjuvant chemotherapy (NAC) to downsize tumours and allow for breast conservation surgery. The present study aimed to use molecular approaches to evaluate the feasibility and accuracy of SLNB in patients treated with NAC prior to SLN mapping and surgery. A total of 50 consecutive patients with operable invasive breast carcinomas who had received prior NAC were assessed using the one-step nucleic acid amplification (OSNA) method. The rate of SLN identification was 100%. The OSNA assay showed that 29 patients (58%) were negative for SLN and 21 patients (42%) were positive. In 19 of these 21 patients (90.48%), the SLN was the only positive lymph node. No axillary lymph nodes metastases were observed in patients with isolated tumour cells or with micrometastases. The OSNA assay is a highly sensitive, specific and reproducible diagnostic technique that can be used to analyse SLNs following NAC. The total tumoral load may assist with predicting additional non-SLN metastases.

Sobrevida con mastectomía radical en cáncer de mama invasor

OBJETIVOS: Comparar las tasas de sobrevida a largo plazo según diversos factores clínico-patológicos y terapéuticos y determinar las tasas de sobrevida y recurrencia decenal luego de mastectomía radical clásica (MRC) y mastectomía radical modificada (MRM). MATERIAL Y MÉTODOS: Revisamos retrospectivamente las historias clínicas de 72 pacientes con carcinoma de mama invasor operable con axila negativa (n=38) o positiva (n=34), tratadas con MRC(n=57) o MRM (n=15) en el Hospital Belén, Trujillo, Perú, desde el 1° de enero de 1966 al 31 de diciembre de 1995. RESULTADOS: La edad media fue 47,6 ± 9,5 años (límites, 30 a 70 años). El tiempo medio de enfermedad fue 9 meses (límites, 0,3 a 156 meses). Los síntomas o signos más frecuentes fueron presencia del tumor (100%) y dolor mamario (37,5%). Las tasas de sobrevida decenal en las pacientes tratadas con MRC y MRM, según el método actuarial de Kaplan-Meier, fueron 58% y 54%, respectivamente (p=NS). No hubo diferencia significativa en la tasa de sobrevida decenal entre el grupo de MRC y MRM al considerar el tamaño tumoral, número de ganglios regionales positivos, nivel axilar comprometido, estadio patológico y tipo de tratamiento. En las pacientes con ganglios axilares negativos hubo una mejora significativa en la sobrevida decenal cuando fueron tratadas con MRC que con MRM (68% contra 38%, p &lt; 0,05). Las tasas decenales de recurrencia local, regional y a distancia en el grupo de MRC, fueron 21 %, 1,8% y 24,6%, respectivamente, mientras que el grupo de MRM las tasas decenales de recurrencia local, regional y a distancia fueron 13,3% 10% y 26, 7%, respectivamente (p=NS). CONCLUSIONES: En pacientes con carcinoma de mama operable, la sobrevida decenal es similar cuando éstas son tratadas con MRC y MRM; sin embargo en las pacientes con ganglios axilares negativos, la sobrevida decenal es influida favorablemente por la MRC.

Cell Proliferation Measured by Ki67 Staining and Correlation to Clinicopathological Parameters in Operable Breast Carcinomas from Vietnamese and Swedish Patients

Background: Cell proliferation measured by Ki67 has recently been shown to be a prognostic and predictive factor in breast cancer. The aim of this study was to compare cell proliferation determined by Ki67 expression with different clinicopathologic parameters among Vietnamese and Swedish women with breast cancer. Materials and Methods:The study was based on series of breast cancer from Vietnamese patients treated in the National Cancer Hospital in Hanoi, Vietnam and from Swedish patients treated in the Karolinska Hospital, Stockholm, Sweden. Cell proliferation was measured by Ki67 staining in an automated procedure and was expressed as percentage of stained tumor cell nuclei. Results:The distribution and mean of Ki67 indices from Vietnamese patients were similar to those estimated from Swedish patients, 27.7% (±17.1%) vs. 26.9% (±23.1%). There were no differences between the two series of patients with respect to proliferation index and age, tumor size and lymph node status. The mean Ki67 indices were higher in high grade tumors in both series. In addition, Swedish patients had significantly higher Ki67 indices in tumors associated with other poor prognostic factors as compared to Vietnamese, 52.8% vs. 31.9% in ER(-) tumors, 39.6% vs. 30.7% in PgR(-) tumors and 40.1% vs. 28.3% in HER2 amplified tumors, respectively. Conclusions: The cell proliferation index in breast cancers was similar in the Vietnamese and Swedish series. High proliferation was associated with poor prognostic factors such as high grade, hormone receptor negativity and HER2amplification.